I recently had a conversation with friends about the role of the placebo effect in alternative medical “therapies” such as acupuncture, Reiki and homeopathy. My friends readily acknowledged that such therapies have no basis in science, but they did believe they had a role to play in modern medicine — precisely because of the placebo effect.
After all, said my friends, if you feel better after, say, undergoing acupuncture or a Reiki session or after taking a homeopathy cold “remedy,” who cares if it’s only the placebo effect at work?
And to some extent, I agree. If you want to waste your money and time on treatments that are really nothing more than “sugar pills” and magical thinking — and you are fully aware that that’s all that they are — then sure, go ahead and do it.
But, of course, it’s not as simple as all that. For alternative therapies are not harm-free.
Some alternative medicines (yes, like conventional ones) can lead to dangerous side effects. Such therapies can also keep people from getting an accurate diagnosis and/or treatment for a medical condition that requires evidence-based care.
Avoiding hard truths
And that can be a very serious matter, as is made clear in an article on this topic that was published online last week in Wired by Alan Levinovitz, an assistant professor of philosophy and religion at James Madison University and the author of “The Gluten Lie: And Other Myths About What You Eat.”
Writes Levinovitz:
When confronted with the possibility of a troubling diagnosis, people often prefer to avoid hard truths. [Yale University neurologist Dr. Steven] Novella tells a gut-wrenching story about one of his patients, who had ALS. After the initial diagnosis, the man left the office, unable to cope with the fact that he had an incurable degenerative disease, likely to kill him within five years. He chose to visit a naturopath instead, who had redemptive news: conventional, narrow-minded medicine had misdiagnosed him. It wasn’t ALS, the naturopath said, but rather chronic Lyme disease, which could be treated with holistic, all-natural supplements.
Nearly a year later, badly degenerated, the man was back in Novella’s office. He’d wasted countless hours and thousands of dollars on false hope. Now, he was willing to listen, but with far less time to prepare for the reality of what lay ahead, and a spirit broken by disappointment. Research suggests this is no mere anecdote. Studies out of Norway, Japan, and Korea have reported higher mortality rates and lower quality of life for cancer patients who pursue complementary and alternative medicine.
(A disturbing variation of this story occurs when Homeopaths Without Borders heads into undeveloped countries after natural disasters (such as the 2010 earthquake in Haiti) to distribute their “treatments” to unsuspecting people — ones who may then not realize they need to seek conventional treatment for their injuries or illnesses.)
An ethical dilemma
As Novella explains to Levinovitz, the recent upsurge in “integrative” medicine — the adding of alternative medicine to conventional medical practices — presents an ethical dilemma for physicians.
“We’ve decided in the medical community that it’s deceptive to prescribe placebos,” Novella says. “So why would it be OK to send someone to a homeopath who’s prescribing sugar pills?”
Another “serious downstream negative effect” of alternative treatments, he adds, is that they change the patient’s perceptions of traditional doctors.
“The patient, who is not properly interpreting the placebo effect, is going to be convinced that they feel better because the principles of acupuncture are true,” says Novella. “Therefore, when they get their cancer, maybe that’s who they’ll go to first.”
Mainstream medicine
There are many reasons, of course, why alternative medicine has stubbornly persisted despite its charlatanism. Part of it has to do with marketing (alternative medicine, like conventional medicine, is a multibillion-dollar-a-year industry — often involving the same large corporations) and part with the public’s lack of scientific knowledge, including how to interpret scientific evidence.
But mainstream medicine is also to blame, as Levinovitz’s article makes clear:
Novella readily acknowledges flaws in our current healthcare system. There’s not enough government research funding, which means corporations have disproportionate influence on the development of new medications. Overtaxed doctors don’t have enough time with patients, forcing them to deliver difficult diagnoses without taking sufficient time to take to answer questions and provide comfort. Doctors, especially surgeons, often have a needlessly gruff and dismissive bedside manner. Reimbursement tends to reward procedures. The list of shortcomings he provides is endless.
But Novella says that recognizing flaws in our healthcare system doesn’t mean giving up on rigorous standards for medicine.
Novella is particularly perturbed that a degree from a naturopathic college — where there is no agreed upon standard of care — counts towards board certification in integrative medicine. As he points out, naturopaths, like the one who misdiagnosed his patient’s ALS as chronic lyme disease, embrace homeopathy, sometimes as a cure for autism. They are also open to chelation treatment and fear of vaccines. “There’s lots of changes that we need to make,” he acknowledges. “But as Paul Krugman says, when the public believes in magic, it’s springtime for the charlatans.”
You can read Levinovitz’s article on the Wired website.
Lumping together types of Complementary and Alternative Medicine
I think that blindly lumping together different types of CAM shows the same sort of lack of scientific thinking that you are criticizing.
I’ll not address Reiki right now as I’ve not looked into it. However, lumping together homeopathy and acupuncture is misleading.
Homeopathy, when referring to the hyper diluted substance in water thing, is pretty clearly bunk with zero evidence to support it and study after study to show that it is useless or, as you describe, worse than useless.
Acupuncture, on the other hand, has been shown via scientific studies to be beneficial when used to treat certain things (migraines) or when used in conjunction with traditional medicine to minimize side effects (like reducing nausea during chemo).
It is most definitely NOT the panacea that some people present it as, but evidence seems to show that it does certainly have a place in a medical practitioners’s tool kit.
Here are some links to read:
Here’s NIH on it (summary, acupuncture works for some things – primarily pain & nausea, tai chi works for some things, a number of supplements don’t work, some are dangerous. they’ve not yet studied massage forms but did find some benefits from spinal manipulation)
http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=85
Here’s Britain’s NHS on what they’ve found acupuncture seems to work for and what there is no evidence to support it for:
http://www.nhs.uk/Conditions/Acupuncture/Pages/Evidence.aspx
And here’s a fluffier piece on the subject:
http://well.blogs.nytimes.com/2012/09/11/acupuncture-provides-true-pain-relief-in-study/?_r=0
As for herbal remedies, as the NIH link above suggests, some of them are certainly bunk, and unlike homeopathy, some of them are actively dangerous.
However, again one should not lump them all together. Each remedy needs to be looked at separately as some most certainly do work. A tincture of white oak bark works very well to stop oral bleeding. On the other hand, Ginko Biloba does NOT work for dementia or Alzeheimers. Two simple examples, but they should illustrate my main point which is that saying “None of them are worth using” is as much of a mistake as saying “All of them are worth using”.
And, in the case of both traditional and alternative medicines, there is a tendency to see something as useful for more things than it is. This holds true in mainstream medicine (surgery, leeching, Acetaminophen, etc.) and alternative or other-cultural medicines like Acupuncture or herbalism. Even if they do have their place, we’ve a tendency to over-ascribe their benefits.
For the average person, my recommendation on the subject would be this:
* For treatment of chronic conditions, be sure to look for confirmed studies when considering using a treatment – alternative OR mainstream. NIH, Mayo, and NHS are all good places to start. For dealing with any chronic condition, check with your primary care provider.
* For treatment of acute conditions, be sure you’ve checked for adverse side effects – Mayo is good for that – but beyond that, feel free to go with personal observation. If it is truly an acute condition and whatever you used worked, then it worked. Obviously, if the symptoms recur, you may want to consider that it may not be acute and flip back to the chronic recommendation. Also, obviously, if the condition is life threatening or threatens permanent injury, get to an emergency room or at least a walk in clinic
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Well said, Jason
You covered most of what I intended to write.
It’s interesting looking at pain as malady, considering the 10-fold rise in unintentional drug overdoses in the US since the early 80s, primarily driven by abuse and over-prescription opioids – which alone kill over 16,000 Americans annually. It also can have related carnage in spreading HIV/AIDS, as we’ve seen recently in rural southern Indiana. Yet oddly we don’t pin that carnage on allopathic medicine, its practitioners, and public policy which has contributed to that situation.
And that’s just one thing that allopathic “cures” have done to increase harm.
Allopathic medicine can be very effective in certain types of applications, but it’s woefully inadequate and often outright harmful when dealing with the systems of the body when they’re not functioning properly. Just look at what over-prescrition of broad spectrum antibiotics has done to digestive health, as one example.
It would be refreshing for this column to conduct a respectful interview with Daniel Church, president of Bastyr, for his perspective on these issues.
Good info
There’s good info here from Mr. Goray. I’m a firm believer in science-based medicine. All of it. That includes “alternative” therapies for the appropriate ill. While I am certain that acupuncture isn’t a cure-all for anything, for some situations, it is certainly more than “in the head” of the patient. Mr. Goray has provided some info on scientific support for acupuncture as a treatment.
The data doesn’t surprise me. I had an interesting experience with acupuncture. For fun, and because I had a credit on the cruise ship I was on, I tried the acupuncture treatment. For the most part, it was unremarkable. I didn’t feel more than a slight tapping sensation as each needle was placed. I thought “eh, at least I didn’t pay extra for this.” And then, she placed a needle in one of my ankles and I had an overwhelming urge to laugh–not because anything was funny, but because my body responded to that needle. It reminded me of a similar experience I had at the end of a yoga class where the instructor had us wind down, not in the normal corpse pose, but in a pose that placed our buttocks against a wall and our legs and feet above our bodies, as though we were sitting on the wall with the floor being the back of the chair. In case you are unfamiliar with the traditional end to a yoga session, the time at the end is taken to consciously relax each part of your body as you focus on your breath. During that session, as we were to focus on our upper legs, I felt a release at the front of my upper legs, which caused me to giggle uncontrollably. Again, it wasn’t amusement (trust me, you don’t want to disrupt the relaxation time with giggling), but a reaction of my body to a stimulus that didn’t seem directly connected to the stimulus.
While these experiences won’t direct me to any “alternative” medicine for treatment of an illness, I do believe that there is evidence that some therapies, such as acupuncture, may provide a benefit that can be measured and attributed to more than just placebo effect. It is too simple to call all of these treatments quackery. To discard the positive effects is as foolish as believing that they can be appropriately used in all scenarios.
Steve Jobs is a good example of alternatives to medicine displacing effective treatment.
He first sought alternative treatment for his cancer, and only got conventional therapy after the alternative was clearly not working.
He certainly died soon because of this; and a cure was possible if he had been treated sooner.
And note that the few peer reviewed studies showing acupuncture to be effective involve conditions like migraine and lower back pain which have no identified physiological cause, and thus can not show any evidence of effective treatment beyond symptom reduction — otherwise known as placebo
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Thank you!
Thank you, thank you, thank you for addressing this important subject. “Alternative” or “complementary” medicine are simply alternatives to science-based medicine, that is to say quackery. Acupuncture has been shown to be no more effective than placebo, including for migraine and chronic pain. It is so disturbing to see institutions like the U of M and Abbot Northwestern Hospital giving credence to such baloney. Honestly curious readers should look to whatstheharm.net and sciencebasedmedicine.org for more information about the true nature of “alternative” practices.
Fads can be harmful
Remember when “est” was a hip “craze” in psychotherapy? How foolish to set up a situation to break down an individual’s defenses without a real professional on hand to help deal with the consequences.
acupuncture
Great comment Jason. Acupuncture has been shown time after time to be more effective than placebo for back pain, which we can’t say for paracetamol/Tylenol.
However, sham acupuncture works about as well for back pain as real acupuncture, and both are twice as effective as conventional therapy. This does not mean there are no benefits, but if you want to get the benefits for less, there are alternatives such as acupressure mats. You can read about the benefits at http://www.osteomat.co.uk. Or you can pay for a trained acupuncture therapist to get the same result… so is acupuncture a scam? Yes. Does it work? Yes!